Dosing and monitoring of Toby

https://www.felinediabetes.com/FDMB/threads/new-member-02-17-21.243297/
Attached is previous thread.
This morning Toby was given 2.25 units instead of his regular 5.5 and we will stick with monitoring at the 2 hour increments again today.

 

Hi Hailey,

Glad to see Deb gave you some good input on dosing yestereve. You're doing great on the home testing.


Mogs
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Gosh you and me both Mogs ! It will be an all day adventure again today but hopefully we can sneak out of the house to go check out some human meters.

 

Go wild in the aisles!


Mogs
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I was calculating it out.. here in Canada the AT2 strips are 2$ a piece! It’s madness, switching to a human meter it will be around 80 cents per strip... big difference!

 

Picked up a human meter. Should I finish this cycle with the AT2 just to keep things simple ?

 

Definitely a good plan.


Mogs
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He’s definitely not dropping much today and numbers are staying quite high. Is it possible that it just takes a few days when coming down so much in a dose or is that he needs a higher dose ?

 

He might be bouncing off yesterday's AM cycle - he dropped over 300 points down to a nadir just over 100. It can take up to 6 cycles for a bounce to clear, during which times numbers may be on the high side. If it is a bounce, you just need to wait it out.


Mogs
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As Mogs said, wait it out.

Let's see what Toby does on the lower 2.25U dose for a few days. Then it's time to reevaluate.
The high carb food is keeping him higher too.
A little soon to change the food up, in my opinion.
Does Toby FEEL ok? We talk about the 5 P's (peeing, pooping, purring, preening, playing) and appetite. So how is he doing on all those factors? Think of it as a handy quick assessment you can do, beyond the BG testing.

If you could pick up some ketone test strips, that's good to test his urine for ketones.

p.s. Thanks for starting the new thread.

 

All of those things he seems totally fine, normal self. I just picked up a human meter today but still testing with AT2 for today. Tomorrow morning I will switch to the human meter if that’s ok since I’m running pretty low on the strips for the AT2. I just did his 10+ and did a test with both the AT2 and the human meter just to make sure I had everything set up for the morning. Still filling in the spread sheet based on AT2 number but his number on the human meter read 15.7 compared to the 20.9 on AT2, quite the difference !

 

Started with the human meter today. Just want to be clear when I go home to check at 6+ what are my safe numbers now that I’m using the human meter? Or are they still the same numbers when using the AT2 ?

 

Safe numbers are the same except for the low number. With the AT2, anything <68 needs intervention with food. With a human meter, anything < 50 needs intervention with food.

 

Since I will eventually be stopping the HC dry food would it be a good idea to pick up some Dr elseys now and begin mixing them together or should I continue to hold off any other changes for now ?

 

Yes, go ahead and pickup some Dr Elsey's chicken flavor dry food.

When you do the food change, depends on what your schedule looks like, and how often you can test.
So what does your work schedule look like?

If you can, I'd feed him more of the Friskies pate, and less of the dry food. If he'll eat more of the Friskies that is. We suggested you cut the dose in half, and you did that. So it could be safer now to feed him less dry food, and more of the low carb wet.

If Toby were my cat, I'd want to monitor more during that food transition. For example, I'd want to test later in the PM, around the +4 time if I could.

 

My work schedule is the same mon-fri every week. It doesn’t change, so I’m only able to do the 6+ test during the day. Maybe I will look at doing the switch this weekend when I can be home with him all day. I’ll pick some up and start mixing this week so their tummy’s can adjust and I will also start to incorporate some canned food at the 6+ hour so hopefully he will be getting less of the dry food.

 

Just jumping on here to ask a question. I switched Toby to friskies pate and dr elseys, no more of his high carb dry food, I made the switch on Saturday. How long can it take before I start to see some improvement of his numbers ? I didn’t expect to see a miracle right away, but thought I’d see some slight improvement. How long before I would need to consider increasing his dose again ?

 

If the food switch is complete, usually you will see better numbers within a week of the food change being finished.

Even though it hasn't been that long for Toby, I think you have held the 2.25U dose for long enough. Please increase the dose to 2.5U with the next cycle.

 

I’ll be sure to do that! Appreciate it Deb. The quarter doses are quite complicated lol

 

Another question, Toby’s AMPS today are the same as his 6+, why would this happen? I noticed it did this a couple weeks ago also just the one day.

 

A flat yellow cycle, sometimes means an active cycle coming up, at least with Lantus and Levemir. I would recommend getting a couple of PM tests tonight, and maybe an extra test or two tomorrow during the day if you can.

 

I will do that, thank you! And what does active cycle mean ?

 

It means that your cat may drop lower than expected during the cycle, and you may need to monitor more, and even intervene with some food.

Flat yellow cycles can mean the same with Prozinc. That your cat is getting ready to clear a bounce, and come back down to some more normal numbers. You may even see some real lows coming up in the next cycle.

 

Well let’s hope for another step in the right direction ! Thanks so much. His PMPS was back to his higher “normal Range” at 19.3

 

I think you are going to need to increase the dose again very soon. Up by another 0.25U.
So Toby's dose would be 2.75U.

Is he still eating the Orijen dry food? Would you please update your User Id Signature to remove that. We'd much rather see what he is eating on the SS, in the Remarks column.

 

He is totally off Orijen food now. I will update that. When should I start him at the 2.75 ? Tomorrow morning ?

 

We kept Toby at 2.5 this morning. He was 16.4. We will see where he is at 6+

 

My recommendation would be to increase on the next cycle where you can monitor.

 

Toby seems a little all over the place still at 2.5. I will be able to monitor him closely this coming weekend, should I stick with only increasing him to 2.75 or would I be able to go right to 3 units ?

 

Prozinc SLGS dosing method says to only increase the dose by 0.25U if the nadirs are >150.
Sticky PROZINC DOSING METHODS

The issue I see is that you have almost no data for the PM cycle, except for the pre-shot test. So you really don't know how low the dose takes Toby in the PM cycle. Without having that information, increasing the dose too much could drop Toby too low.

 

Are their numbers prone to going lower in the PM ? In the last few days I noticed not much of a change in numbers at his 6+ so it’s making me feel like he’s getting used to the dose again. It’s like at first he seems to do better on a lower dose but then in a week it goes back to the same or starts getting worse again. I’m worried next thing you know we are going to be right back up to giving 5 units of insulin after starting all over again. It’s making me loose a little bit of hope of becoming regular. I’ll start at the 2.75 then. Only thing I can get from him after PMPS would be a 2 or 3+ and I don’t know how much that will really show since he would still have access to his food and isn’t really close to his nadir, seems like every time we do a 2+ test it’s usually higher than his PMPS or AMPS

 

Is dr elseys salmon flavour okay temporarily ? My local
Store is out of chicken and I would have to travel quite a way for the chicken

 

Correction, nobody even within a 2 hour distance has any so it’s going to have to do to go along with his friskies pate.

 

No, the salmon flavor of Dr Elseys is too high in carbs 11-13% for the dry kibble.
I just used this calculator, and replied in Peeka's thread a couple of minutes ago. Talk about serendipity.

http://www.scheyderweb.com/cats/catfood.html

Yes.
Cats are usually more active at night, so they use more energy and that uses up more of the glucose.

 

I tried to go back on some posts on Facebook and some said it was 9% so I thought it was okay, luckily I haven’t given him any yet. We have a problem, I’ve checked everywhere in our province, everyone is sold out, Amazon as well and even right on Dr. elseys website... my Plan B is just to give more cans of food and have him strictly on the friskies pate until a store gets more in stock. Thankfully I had just picked up a small bag of the salmon and it was 50% off so not much of a lose.

 

Every post I can find on FD Facebook page is everyone saying it’s 9 something percent. So not sure if that calculator your using is off by chance ? But still I don’t think it’s worth it to take the chance especially when we are trying to get regulated... we definitely DO NOT need another step in the wrong direction. I will scrap the salmon and stick to only the friskies pate until some of the chicken flavour becomes available again. Thanks Deb ! As of late Toby is still a bit all over the place, this coming weekend should I increase again if things don’t get better by then ?

 

Toby has gone down to 8.5 for his 6+ ... it’s making me wonder if it’s due to the increase in dose or starting to think perhaps the dr elseys dry food was playing a role in the higher numbers? He hasn’t had any dry food now for 2 days.

 

A nice BLUE BG at mid-cycle for Toby today.
Yes, the dry food could be playing a role in Toby's higher numbers.
Although many people like to feed that Dr. Elsey's, I've read of other people seeing a difference, an improvement in the BG numbers, once they cut that out of their cat's diet.

No, I don't think the carb calculator I used was inaccurate. It's one of the commonly used ones here.
The Friskies pates are usually in the 7-10% carb range. The Mixed Grill flavor is on the high side.
If Toby will eat the wet food, it's better for his body, to keep him hydrated with a wet food than a dry kibble.
Cats have a low thirst drive, so wet food works so much better for them.

Let's not "count our chickens before they have hatched." It's better to see where Toby's BG levels go with this diet change.

Don't be surprised if he bounces at PMPS. His body isn't used to those low blue BG numbers.

 

A nice BLUE BG at mid-cycle for Toby today.
Yes, the dry food could be playing a role in Toby's higher numbers.
Although many people like to feed that Dr. Elsey's, I've read of other people seeing a difference, an improvement in the BG numbers, once they cut that out of their cat's diet.

No, I don't think the carb calculator I used was inaccurate. It's one of the commonly used ones here.
The Friskies pates are usually in the 7-10% carb range. The Mixed Grill flavor is on the high side.
If Toby will eat the wet food, it's better for his body, to keep him hydrated with a wet food than a dry kibble.
Cats have a low thirst drive, so wet food works so much better for them.

Let's not "count our chickens before they have hatched." It's better to see where Toby's BG levels go with this diet change.

Don't be surprised if he bounces at PMPS. His body isn't used to those low blue BG numbers.

You really do need to try and get some more PM BG readings too. Without those, you only see half the data.

 

Good to know about the carb calculator I will save that one for future use, thank you ! I will be checking Toby in the next 45 minutes so I will come back here with an update! Fingers crossed he is back up and hasn’t dropped any lower.

 

23.1 now! Poor guy lol

 

I will work on getting more PM data! Probably would only be about a 3+ but better than nothing !

 

All data is good data.

 

Please tell me I did the right thing by giving Toby his full dose tonight. He was at 225, I will be able to stay up later to monitor him more closely.

 

Be sure to get at least 1 more test before you head off to sleep.
If you can manage 2 tests, perhaps by setting an alarm, that's even better.

 

I will be sure to stay up probably at about 5+. Just incase, what number would I want to intervene with the higher carb wet food or potentially vet visit ? Is it below 50? Or am I mistaken ?

 

I left Toby’s bottle of insulin out all night. Is it still okay or do I need new stuff now ?

 

It's fine.

Yes, any number below 50 means higher carb food. Also, it depends on when in the cycle those lows occur. Early in the cycle, before onset or close to it, then more monitoring and support with food would be needed. It's knowing how your cat reacts to the insulin and when, that determines your next steps.

Looks to me like Toby could use an increase in dose. He's been at this 2.75U dose for 17 cycles, which is long enough to see if it's working for him.

He needs to be getting BG levels down in the lower blues and even the greens.

 

Sounds good, I will increase to 3 units, thanks Deb.

 

Hailey, would you please create a new thread and link this old thread at the top of the new thread? We like to keep threads at 50 replies when we can.

Here's hoping the dose increase helps Toby.